Reimbursement specialist Jobs in Washington, DC

Position : TRICARE Reimbursement Program Policy Analyst (Lead) Location : Falls Church, VA Work Environment : Hybrid Clearance Required : None

Status : Contingent Upon Contract Award

Knowesis is seeking a Senior Healthcare Policy Analyst Lead to provide subject matter expertise in support of the TRICARE health plan. The Senior Policy Analyst leads a team of health professionals in developing health plan reimbursement policies that further the strategic goals of the Department of Defense / Defense Health Agency to provide the highest quality of care to Military Health System beneficiaries.

The policy analysts analyze TRICARE reimbursement program policies in comparison to other Government and private health care programs. Services assist to identify the need for and evaluate the effectiveness and efficiency of reimbursement program changes. Identify practices designed to circumvent TRICARE reimbursement cost control, incorporate policy projects in the TRICARE Manuals, and support development of national guidelines regarding TRICARE program coverage in the areas of medical benefits, provider certification, reimbursement and special benefits.

To be eligible for this position, candidates must possess U.S. Citizenship without the need for sponsorship, both now and in the future. Applicants without proof of U.S. Citizenship will not be considered due to the position's security clearance requirements.

The Job Duties and Responsibilities include but are not limited to the following :

• Analyze program policies and support the development of reimbursement policies and principles.
• Analyze relationships of TRICARE reimbursement program policies and principles to those present in other Government and private health care programs, based upon cost and impact analysis, and provide recommendations to the government in developing operational policies and establishing guidelines for TRICARE reimbursement operations and practices.
• Identify the need for changes and evaluate the effectiveness and efficiency of reimbursement program modifications.
• Provide analytical support to senior staff by reviewing, analyzing, and editing various documents, including policy, legislation, and reports.
• Formulate recommendations based on current issues, legislation, programs, and regulations.
• Ensure compliance with TRICARE policies, healthcare benefits, and reimbursement systems.
• Aid in developing implementation guidance and operational principles for reimbursement of health care providers and suppliers.
• Initiate reimbursement program policy recommendations.
• Utilize the analysis of Government and private healthcare program patterns of reimbursement, legislation, administrative proposals, and operational experience to identify potential changes to the reimbursement policy.
• Review literature and Federal Register publications to evaluate the effectiveness and efficiency of adopting new reimbursement systems and / or changing or updating existing systems.
• Conduct research, review and analysis on problems and highly complex provider reimbursement issues. Develop a program of analyzing these practices documenting results, identifying practices that represent potentially erroneous program reimbursement, and recommending appropriate remedies as well as means of further investigation and control in the context of complex, rapidly changing and diverse billing and charge practices of health care providers, .
• Develop background and position papers on reimbursement issues that focus on those practices adopted by providers designed to circumvent or offset cost controls of TRICARE reimbursement and the results of reimbursement regulations and instructions implemented to meet specific program cost control problems.
• Document all policies and develop the organization and maintenance procedures for such policies. For all assigned policy projects, assist with development and coordination of the approved changes of the TRICARE Policy Manual, the TRICARE Reimbursement Manual, the TRICARE Operations Manual, the TRICARE Systems Manual and new releases.
• Assist the Government Point of Contact with the administration of responses to inquiries from military services, Congress, the Office of Management and Budget (OMB), the Government Accountability Office (GAO), and other governmental and nongovernmental agencies regarding TRICARE reimbursement issues and provides those entities administrative support, coordination, advice, and evaluation relative to TRICARE reimbursement policies research, write, develop, evaluate and coordinates program and policy changes and initiatives for new and emerging technologies.
• Update and monitor the TRICARE Reimbursement website to ensure currency and accuracy of information.
• Support quarterly updates to reimbursement systems, including participating in research coding, healthcare Contractor meetings and other venues to resolve questions / comments regarding current TRICARE payment and policies.
• Support the development of national guidelines regarding TRICARE program coverage in the areas of medical benefits, provider certification, reimbursement, and special benefits. Perform

Required Qualifications :

Benefits :

Knowesis is an Equal Opportunity Employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.